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Candida glabrata meningitis in a patient with newly diagnosed acquired immunodeficiency syndrome from Sikkim, India

Summary

A middle-aged woman in India was admitted with severe headaches and was found to have a rare fungal infection of the brain (meningitis) caused by Candida glabrata, a type of yeast. She had recently been diagnosed with AIDS and had very low immune cell counts. Although doctors tried multiple antifungal medications, the yeast showed resistance to these drugs and the patient’s condition worsened, ultimately leading to her death. This case highlights how dangerous fungal infections can be in people with severely weakened immune systems.

Background

Candida infections in India have shifted toward increased incidence of invasive candidiasis caused by non-albicans species. Central nervous system infections by Candida glabrata are sparsely reported. This case study presents a rare occurrence of C. glabrata meningitis in a patient with newly diagnosed AIDS and pulmonary tuberculosis.

Objective

To report and analyze an unusual case of C. glabrata meningitis in a middle-aged female with newly diagnosed AIDS and low CD4 count, and to discuss the diagnostic and therapeutic challenges associated with this infection.

Results

CSF culture grew C. glabrata, confirmed by MALDI-TOF analysis. The patient had a CD4 count of 12 cells/mm3 and was initially treated with fluconazole, then switched to amphotericin B and flucytosine. Antifungal susceptibility testing showed resistance to amphotericin B and flucytosine by Vitek 2 (MIC 2 µg/mL for both). Despite appropriate therapy, the patient’s condition deteriorated with complications including kidney dysfunction and hypokalemia, leading to death on day 9 of hospitalization.

Conclusion

This case emphasizes the high mortality associated with C. glabrata meningitis in immunocompromised patients and the challenges in diagnosis and treatment. The intrinsic resistance of C. glabrata to azoles and other antifungals, combined with severe immunosuppression, contributed to the fatal outcome. Improved fungal diagnostics and availability of broader antifungal agents including echinocandins are needed in resource-limited settings.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 39744337, DOI: 10.22034/CMM.2024.345242.1542
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